Obesity is one of the strongest risk factors for obstructive sleep apnea (OSA), and the two conditions often influence each other in significant ways. Excess body weight can narrow the airway and make it more likely to collapse during sleep, while untreated OSA can disrupt hormones that regulate appetite, metabolism, and energy levels, making weight management more challenging.
Learning about the relationship between obstructive sleep apnea and obesity can help you understand your risk, the benefits of treating each condition, and when to talk to your doctor about your nighttime breathing and the quality of your sleep.
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How Does Obesity Impact Your Health?
Obesity is a common disease that affects metabolism and the regulation of body weight. Although a person’s behavior can contribute to weight gain, it’s important to note that lifestyle is only one risk factor for obesity. The risk of developing obesity is also related to a person’s genetics, other health conditions, stress, and their environment.
Having obesity is associated with an increased risk of health complications such as:
- Type 2 diabetes
- High blood pressure
- Heart disease
- Cancer
- Metabolic syndrome
- Osteoarthritis
Though obesity is linked to a variety of negative health consequences, not all people with obesity have the same risk of complications. For example, a high amount of fat in the abdomen is more strongly associated with certain health risks compared to fat stored in the hips and thighs. Additionally, people with obesity are also at risk of mental health conditions such as depression.
Body Mass Index (BMI)
Obesity is determined by calculating your BMI, which takes into account your weight and height and estimates your amount of body fat. Your BMI can fall into one of four weight categories.
| BMI | Weight Category |
|---|---|
| Less than 18.5 | Underweight |
| 18.5-24.9 | Healthy weight |
| 25-29.9 | Overweight |
| 30 or above | Obesity |
Keep in mind that BMI cannot distinguish between weight caused by body fat, muscle mass, or bone mass. So, it’s possible to have an elevated BMI due to factors other than having excess body fat.
Does Obesity Cause Sleep Apnea?
Research shows that the risk of developing obstructive sleep apnea increases with a person’s BMI. Obesity increases a person’s chances of developing OSA due to the effects of excess body fat on breathing during sleep. Obesity can reduce the size of the airway, lower lung capacity, and make the throat more likely to collapse while a person sleeps.
People with mild narrowing of their airway may snore at night, while those with significant narrowing have periods where their breathing is restricted or paused. Obstructive sleep apnea causes a person to wake up repeatedly at night and experience fluctuations in the levels of oxygen and carbon dioxide in their blood, both of which increase the risk of further health complications.
Sleep Apnea and Obesity Hypoventilation Syndrome
Obesity hypoventilation syndrome (OHS) is another breathing disorder that can affect people diagnosed with obesity, especially those with a BMI higher than 50. Although experts don’t know the cause of OHS, research suggests that OHS also develops because of the strain that obesity can place on the body’s respiratory system.
More than 90% of people who have obesity hypoventilation syndrome also have obstructive sleep apnea. Accordingly, there’s usually an overlap between symptoms of OSA and OHS, such as daytime sleepiness and loud snoring.
Sleep Apnea and Obesity in Children
An estimated 1% to 5% of children have obstructive sleep apnea, and children who have enlarged tonsils or obesity are most at risk. Research suggests that children with obesity may be four to five times more likely to develop OSA compared to children without obesity.
Obesity in children and adolescents can also be measured using BMI, but their results are interpreted differently than for adults. Because body fat can change drastically during youth, the BMI of a child or adolescent is usually compared to the BMI of others who share the same age and sex.
| Percentile of BMI | Weight Category |
|---|---|
| Lower than the 5th percentile | Underweight |
| 5th-85th percentile | Healthy weight |
| 85th-95th percentile | Overweight |
| 95th percentile or higher | Obesity |
Does Sleep Apnea Cause Weight Gain?
While having obesity increases a person’s risk of developing obstructive sleep apnea, some experts suggest that the opposite might be true as well. While no studies have definitively proven this link, having OSA may increase the risk of obesity.
Obstructive sleep apnea may cause weight gain due to the effects of OSA on the hormone leptin. Leptin affects how much people eat by helping the body to recognize when it’s full.
OSA increases the amount of leptin in the body and may contribute to leptin resistance. This may be because nighttime breathing disruptions trigger the release of cortisol, which affects leptin and leptin resistance. People with leptin resistance feel less satiated, leading to increased food intake and weight gain.
Continuous positive airway pressure (CPAP), the most common and effective treatment for sleep apnea, can also cause weight gain. Doctors are unsure of why some people gain weight after starting CPAP therapy but maintain that the health benefits of this treatment continue to outweigh the risks.
Does Losing Weight Help Sleep Apnea?
Treatment for obesity can help prevent or reduce health complications associated with a high BMI, including obstructive sleep apnea. To treat obesity, doctors may recommend weight loss and other lifestyle changes, medications, or surgery.
Weight loss reduces nighttime breathing obstructions, improves blood pressure, and enhances overall health. Exercise alone, even without weight loss, may also decrease the symptoms of OSA while improving cardiovascular health.
Although weight loss is a common recommendation from doctors, research shows that maintaining weight loss long-term is challenging. This is because the body attempts to remain at a stable weight and, during periods of calorie restriction, the body undergoes hormonal changes and increases hunger to regain lost weight.
When considering losing weight, it can be helpful to talk to a doctor about healthy weight management. Doctors can offer a referral to a nutritionist or dietician for support in finding a weight-loss program that provides counseling, goal-setting, monitoring, feedback, and support during the program.
Zepbound for Sleep Apnea
In December 2024, the U.S. Food and Drug Administration (FDA) approved the prescription weight-loss drug Zepbound as a treatment for moderate to severe obstructive sleep apnea in adults with obesity.
Zepbound contains tirzepatide, a medication that works by targeting hormones involved in appetite regulation and blood sugar control, helping people lose weight. Clinical trials showed that people who used Zepbound experienced significant reductions in their apnea-hypopnea index (AHI), meaning fewer breathing disruptions during sleep.
Other Treatments for Sleep Apnea and Obesity
While weight loss can improve sleep apnea symptoms for many people with obesity, it’s rarely the only treatment needed.
- CPAP therapy: CPAP therapy remains the most effective first-line treatment for obstructive sleep apnea because it keeps the airway open throughout the night, regardless of body weight.
- Oral appliances: Some individuals may also benefit from oral appliances that reposition the jaw, positional therapy to reduce back-sleeping, or surgery to address structural airway issues.
- Bariatric surgery: In some cases, bariatric surgery may be appropriate and can lead to long-term improvements in both weight and OSA severity.
Working closely with a sleep specialist and a metabolic or weight-management provider can help create a treatment plan that addresses both conditions safely and effectively.
When to Talk to Your Doctor
Contact your doctor if you have concerns about your breathing or experience symptoms of sleep apnea, like loud snoring, gasping for air, awakening tired and unrefreshed, or daytime sleepiness. A doctor can evaluate your symptoms, perform a physical examination, and recommend a sleep study to find out the cause of your breathing problems.
You may not be aware of nighttime breathing issues, so it’s also important to talk to a doctor if a family member, caregiver, or bed partner reports that you are snoring loudly, gasping for air during sleep, or having other breathing changes during the night. You may want to have your bed partner come with you to an appointment to discuss your symptoms with your doctor.
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Written by
Martinique Edwards, Staff WriterMartinique writes content focused on sleep health, science, and trends. She graduated from the University of Georgia with a bachelor’s degree in Ecology and master’s degree in Environmental Health and has research experience in environmental microbiology and aquatic science. Martinique loves to view the world through an ecological lens, where everything is interconnected. In her free time, she enjoys outdoor activities such as running and parkour.
Reviewed by
Howard Hoffman, DDS, Medical ReviewerDr. Howard J Hoffman was born and grew up in New York. After attending the Ohio State University -B.S. 1970, he attended The University of Maryland School of Dentistry, earning his DDS degree in 1974. Dr. Hoffman served 2 years in the U.S. Public Health Service in Guam from 1974-1976. Upon returning to the continental U.S., he opened a private dental practice and began his studies in Implant Dentistry in the mid-90s, including two 18-month programs, first with the American Academy of Implant Dentistry, followed by a second at Harvard University.
